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I'm partnered with a top Medicaid Health Plan in San Diego to find a community-oriented Medical Director to join the team!

This health plan is ranked #1 or #2 in all meaningful quality measures, so you know you’re joining a high-performing plan with quality as their mainstay. They’ve invented the wheel with automation and efficiency- making referrals and other tasks a snap. They put member satisfaction and wellness at the forefront of everything they do, making each decision in the best interest of their members.

With 2 other medical directors in place and a solid C-suite team (most of whom have been here for over a decade), you’ll be joining with the security of knowing this organization isn’t going anywhere but up.

They have around 360,000 members to date and plan to have over 400,000 by the new year. They’re also growing their internal team by 40-50 employees over the next 5-6 months.

This plan has figured it out, putting the member first and always remembering the “why” behind the things you do keeps them on the track to success.

Passion takes the lead for this CEO; you’ll learn in the first 2 minutes of your conversation with him that he could not care more about the underserved community and that is what drives his leadership. If you’ve been in a role that isn’t passionate about the population that you care for, this will no doubt be a refreshing twist in your career.

Focus of the Medical Director

• Report to the CMO.
• Work alongside the Case Management team supporting appropriate care plans for all members.
• Work closely with the Quality Department leading the way through grievances and clinical denials.

Role Specs

• On site 5 days per week in San Diego
• Competitive Salary with Full Benefits
• Growth trajectory
• Visible and accessible C-suite
• Top quality- you can be proud of what you represent

Responsibilities

• Manage and control medical utilization by providing daily guidance and clinical supervision to the Health Care Services Division for prior authorization requests, formulary exception requests, concurrent review of inpatient and outpatient care, individual case management and behavioral health.
• Review and approve follow-up actions for any clinical grievances.
• Participate in the on-going Individual Care Team meetings and review and approve Individual Care Plans as required.
• Maintain on-going communication and face-to-face contact with contracted providers.
• Ensure all services are medically necessary, provided in an appropriate setting and at an appropriate level of care; review care with physicians and suggest alternative treatment plans when indicated; make recommendations about utilization management or contracting that will assist in the best use of medical services.

Working as a leader in a top-ranking health plan who’s sole focus is making an impact on their members lives will give you the satisfaction you’re seeking in your healthcare career.

If you’re someone who’s a change-maker and deeply cares about making a difference, especially in these underserved communities who need it the most, let’s talk.

I’m excited to share more about this company and work together to identify if this opportunity aligns with your career goals.

Qualifications for the Medical Director:

• Medical degree and relevant board certification.
• CA medical license.
• Proven experience working in a health plan, managed care, or Medicaid model.

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